<div ng-app="myApp" ng-controller="ListCustCtrl">
<h2>Add Cancellation</h2>
 
<form novalidate name="AddNewForm" id="add-new-form" method="post" action="">
  <table>
    <tr>
		<td>Date : </td>
		<td><input type="date" ng-model="canc.Can_Date"></td>
		<td>Agent Name :  </td>
		<td><select ng-model="clist" ng-options="cust.Name+' ('+cust.custtype+')' for cust in customermast " ></select> </td>
	<!--	<td><select ng-model="cust.custid" ng-options="cust.Name+' ('+cust.custtype+')' for cust in customermast " ></select> </td> -->
		{{clist.custid }} 
		</tr>
    
    <tr>
		<td>PAX Name : </td>
		<td><input type="text" name="Pax_Name" ng-model="canc.Pax_Name" capitalize> </td>
		<td>No of PAX : </td>
		<td><input type="number" ng-model="canc.No_of_Pax"></td>
    </tr>
    
    <tr>
      <td>Airline: </td>
	  <td><input type="text" name="Airline" ng-model="canc.Airline" capitalize> </td>
      <td>Sector: </td>
	  <td><input type="text" name="Sector" ng-model="canc.Sector" capitalize> </td>
      <td>Net Rate: </td>
	  <td><input type="number" ng-model="canc.Net_Rate"></td>
    </tr>
    
    <tr>
	    <td>Refund Amt: </td> 
		<td><input type="number" ng-model="canc.Refund_Amt"></td>
        <td>Refund Date: </td>
		<td><input type="date" ng-model="canc.Refund_Date"></td>
        <td>Agent Rate: </td>
		<td><input type="number" ng-model="canc.Agent_Rate"></td>
	</tr>
	<tr>
		
        <td>Agent Ref Amt: </td>
		<td><input type="number" ng-model="canc.Agent_Ref_Amt"></td>
         <td>Reference Date: </td>
		 <td><input type="date" ng-model="canc.Reference_Date"></td>
         <td>Comment: </td>
		 <td><input type="text" ng-model="canc.Comment"></td>
	</tr>
	
  </table>
        <button class="btn btn-primary" ng-disabled="AddNewForm.$invalid || isUnchanged(canc)" id="add-new-btn" ng-click="add_new(canc,clist.custid)">Save!</button>
        <a href="#/editcanc/" class="btn">Cancel</a>
    </div>
	    <form>
    <div class="row">
        <div class="col-xs-4">
            <div class="input-group">
                <span class="input-group-addon"><span class="glyphicon glyphicon-user"></span></span>
                <input type="text" class="form-control" placeholder="Username">
            </div>
        </div>
        <div class="col-xs-4">
            <div class="input-group">
                <input type="text" class="form-control" placeholder="Amount">
                <span class="input-group-addon">.00</span>
            </div>
        </div>
        <div class="col-xs-4">
            <div class="input-group">
                <span class="input-group-addon">$</span>
                <input type="text" class="form-control" placeholder="US Dollar">
                <span class="input-group-addon">.00</span>
            </div>
        </div>
    </div>
</form>